OP0124 FETAL AND MATERNAL MORBIDITY IN PREGNANT SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) PATIENTS: A 10-YEAR U.S. NATIONAL STUDY
Authors: B. Mehta, K. K. J. Glaser, D. Jannat-Khah, Y. Luo, L. Sammaritano, J. E. Salmon, S. Goodman, F. Wang
Journal: Annals of the Rheumatic Diseases (2022)

Background Systemic lupus erythematosus (SLE) is an autoimmune disorder that affects women in their childbearing years. Previously, we demonstrated that fetal and maternal mortality has declined in SLE patients over the years, however little is known about morbidity (1). Objectives To determine the proportion of fetal and maternal morbidity in SLE deliveries compared to non-SLE deliveries in a US nationwide study over a decade. Methods We used retrospective data from the National Inpatient Sample database to identify all delivery related hospital admissions of patients with and without SLE from 2008 to 2017 using ICD-9 (710.0) and 10 (M32*) codes. Fetal morbidity indicators included preterm delivery and intrauterine growth restriction. 21 indicators of severe maternal morbidity were identified using the standard CDC definition: these are unexpected outcomes of labor and delivery that result in significant short- or long- term consequences to a woman’s health (2). Descriptive statistics and their 95% confidence intervals were calculated using sample weights from the dataset. Results Among the 40 million delivery-related admissions, 51,161 patients (10,297 unweighted) were reported to have SLE. SLE patients were more likely to be older and have more comorbidities compared to non-SLE patients (Table 1). Patients with SLE had a higher risk of fetal morbidity, including intrauterine growth restriction (8.0% vs 2.7%) and preterm delivery (14.5% vs 7.3%) than patients without SLE. Amongst the CDC maternal morbidity indicators - SLE patients faced a greater risk of blood transfusion, puerperal cerebrovascular disorders, acute renal failure, eclampsia or DIC, cardiovascular and peripheral vascular disorders, and general medical issues than those without SLE (Figure 1). Table 1. Characteristics for deliveries of patients with and without Systemic Lupus Erythematosus SLE deliveries Non-SLE deliveries Percent (% ) (95 %CI ) Percent (% ) (95 %CI ) N 51,161* (10,297 unweighted) (49,419.14, 52,903.37) 40,000,000* (8,055,025 unweighted) (39,200,000; 40,700,000) Age (years) 30.05 (29.92, 30.18) 28.19 (28.14, 28.24) Race White 46.15 (44.83, 47.47) 52.43 (51.74, 53.11) African American 24.68 (23.55, 25.85) 15.01 (14.62, 15.42) Hispanic 18.48 (17.40, 19.60) 21.45 (20.81, 22.10) Other 10.69 (9.93, 11.50) 11.11 (10.76, 11.47) Insurance Medicare 5.32 (4.83, 5.86) 0.7 (0.66, 0.75) Medicaid 38.2 (37.00, 39.41) 43.79 (43.20, 44.39) private insurance 51.84 (50.55, 53.13) 49.8 (49.15, 50.45) self-pay 1.39 (1.13, 1.70) 2.74 (2.57, 2.92) no charge 0.04 (0.02, 0.12) 0.13 (0.09, 0.18) other 3.21 (2.84, 3.63) 2.84 (2.73, 2.95) Elixhauser 0 0 (*no obs) 80.56 (80.32, 80.80) 1 to 4 97.84 (97.50, 98.12) 19.4 (19.16, 19.64) 5+ 2.16 (1.88, 2.50) 0.04 (0.03, 0.04) *Population weighted values are listed. Figure 1. Fetal and severe maternal morbidity outcomes in Systemic Lupus Erythematosus (SLE) and non-SLE patients. Cardiovascular and peripheral vascular disorders include acute myocardial infarction, aneurysm, amniotic fluid embolism, cardiac arrest/ventricular fibrillation, heart failure, pulmonary edema/acute heart failure, sickle cell disease with crisis, air and thrombotic embolism, and conversion of cardiac rhythm. General medical issues include hysterectomy, shock, sepsis, adult respiratory distress syndrome, and severe anesthesia complications, temporary tracheostomy, and ventilation. Conclusion Our study demonstrates that fetal morbidity and severe maternal morbidity occur at a higher rate in patients with SLE compared to those without, even in this most recent decade. This work can help inform physicians to counsel and manage patients with SLE during pregnancy and its planning. References [1]Mehta B, et al. Trends in Maternal and Fetal Outcomes Among Pregnant Women With Systemic Lupus Erythematosus in the United States: A Cross-sectional Analysis. Ann Intern Med. [2] https://www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.html Acknowledgements This work was supported by the Dean’s Diversity Award at Weill Cornell Medicine. Disclosure of Interests Bella Mehta Speakers bureau: Novartis and Jassen, Katharine Kayla J Glaser: None declared, Deanna Jannat-Khah Shareholder of: Cytodyn, AstraZeneca, and Walgreens, Yiming Luo: None declared, Lisa Sammaritano: None declared, Jane E. Salmon: None declared, Susan Goodman Consultant of: UCB, Grant/research support from: Novartis, Employee of: Current Rheumatology Report (section editor), Fei Wang: None declared